刘胜强

【摘要】 目的：腹瀉是儿科常见疾病，其治疗方式多是肠道保护与菌群调节相结合，本文采用双歧三联活菌片联合蒙脱石散治疗腹泻患儿，观察其对血清免疫蛋白、血锌水平的影响。方法：选取2017年6月1日-2018年6月1日笔者所在医院儿科腹泻患儿198例，密封信封法分为对照组和联合组，每组99例，对照组在基础治疗上予以蒙脱石散治疗，联合组在基础治疗上予以双歧三联活菌片联合蒙脱石散治疗，观察两组临床常见体征指标和症状缓解时间，比较其治疗前后免疫功能、肠道主要菌群和血锌的变化。结果：联合组血常规恢复时间、粪常规恢复时间、体温恢复时间、腹痛和呕吐缓解时间均早于对照组，差异均有统计学意义（t=15.95、14.12、13.07、18.74、20.86，P<0.05）;治疗后，两组患儿免疫球蛋白A、免疫球蛋白G、CD4+、CD4+/CD8+均升高，CD8+均降低，且联合组各指标均优于对照组，差异均有统计学意义（P<0.05）;治疗后，两组乳杆菌属、肠球菌属数量均升高，酵母样真菌均降低，且联合组菌群均优于对照组，差异均有统计学意义（P<0.05）;治疗后，两组血锌水平均提高，且联合组高于对照组，差异均有统计学意义（P<0.05）。结论：双歧三联活菌片联合蒙脱石散能够促进患儿体征指标和临床症状的恢复，显著改善腹泻患儿血清免疫蛋白水平，提升血锌，改善肠道菌群。

【关键词】 双歧三联活菌片 蒙脱石散 腹泻患儿 血清免疫蛋白 血锌

doi：10.14033/j.cnki.cfmr.2019.28.002 文献标识码 A 文章编号 1674-6805（2019）28-000-04

Effects of Bifid Triple Viable Tablet Combined with Montmorillonite Powder on Serum Immune Protein and Blood Zinc Levels in Children with Diarrhea/LIU Shengqiang. //Chinese and Foreign Medical Research， 2019， 17（28）： -7

[Abstract] Objective： Diarrhea is a common disease in department of pediatrics， and its treatment regimen is mostly combination of intestinal protection and flora regulation. In this paper， Bifid Triple Viable Tablet combined with Montmorillonite Powder was used for children with diarrhea to observe the effects on serum immune protein and blood zinc levels. Method： A total of 198 children with diarrhea in department of pediatrics of our hospital from June 1， 2017 to June 1， 2018 were selected and divided into control group and combined group according to the sealed envelope method， with 99 cases in each group. The control group was given Montmorillonite Powder on the basis of basic treatment， and the combined group was given Bifid Triple Viable Tablet combined with Montmorillonite Powder on the basis of basic treatment. The relief times of clinical common signs and symptoms were observed in the two groups， and the immune function， intestinal major flora and blood zinc were compared before and after treatment. Result： The recovery time of blood routine， fecal routine recovery， body temperature， abdominal pain and vomiting in the combined group were significantly earlier than those in the control group， the differences were statistically significant （t=15.95， 14.12， 13.07， 18.74， 20.86， P<0.05）. After treatment， the immunoglobulin A， immunoglobulin G， CD4+， CD4+/CD8+ increased and CD8+ decreased in the two groups， and the indexes in the combined group were better than those in the control group， the differences were statistically significant （P<0.05）. After treatment， the number of Lactobacillus and Enterococcus increased and the number of Yeast-like fungi decreased in the two groups， and the flora of the combined group was better than that of the control group， the differences were statistically significant （P<0.05）. After treatment， the level of serum zinc in the two groups was increased， and the level of serum zinc in the combined group was higher than that in the control group， and the differences were statistically significant （P<0.05）. Conclusion： Bifid Triple Viable Tablet combined with Montmorillonite Powder can promote the recovery of physical signs and clinical symptoms of children， significantly improve serum immune protein level， enhance blood zinc and improve intestinal flora in children with diarrhea.

有研究表明，肠道菌群、锌、维生素A等微量物质与免疫水平密切相关，而免疫力下降是造成小儿腹泻的发生及长期不愈的主要内在因素，IgA、IgG、CD4+、CD8+及CD4+/CD8+及血锌水平等均可指示免疫功能，因此，调节肠道菌群，促进锌、维生素等物质的吸收，提高该类指标是治疗小儿腹泻的关键[13]。在本研究中，联合组免疫指标、肠道菌群改善水平和血锌水平均显著优于对照组，其原因在于蒙脱石散的有效成分覆盖肠道，阻止肠黏膜脱落，通过保护肠道黏膜间接保护消化功能，纠正水电解质平衡;同时，双歧三联活菌片补充正常菌群，抑制致病菌和致炎菌繁殖，调节肠道酸碱平衡，通过酸化肠道促进胃肠蠕动，增加钙离子、锌离子、维生素等物质的吸收，提高免疫力。……